LEA - Angiology

Question 1

which three arteries are remnants of the sciatic (axis) artery?

Answer 1

1. inferior gluteal a.
2. popliteal a.
3. peroneal a.

The sciatic artery is the primordial blood supply to the lower limb. It arises from the umbilical artery and terminates in a foot plexus around week 5 of gestation. During weeks 6 and on, the sciatic artery retreats and leaves these remnants. In rare cases, a persistent sciatic artery (PSA) may occur.

Question 2

at what level of the spine does the descending aorta divide into the common iliac arteries?

Answer 2

L4

• The left and right common iliac arteries then give rise to the internal and external iliac arteries*
• Trick: Bifourcation of aorta is located at L4*

Question 3

compression of the left common iliac vein by which artery may lead to persistent pain, swelling and possible blood clots in the left lower extremity?

Answer 3

Right common iliac a.

(known as May-Thurner Syndrome)

Trick: You can remember that this occurs around the L4 vertebral level because the number “4” crosses over itself.

Question 4

what are the branches of the internal iliac artery?

Answer 4

Anterior trunk:

• Internal pudendal a.
• Inferior gluteal a.
• Obturator a.

Posterior trunk:

• Iliolumbar a.
• Superior gluteal a.
• Lateral sacral a.

Question 5

the femoral artery is the continuation of what artery?

Answer 5

External iliac a.

• This change in name occurs once the artery traverses beneath the inguinal ligament.*
• The external iliac a. also gives rise to the deep circumflex iliac a. and the inferior epigastric a.*

Question 6

what arteries make up the cruciate anastamosis?

Answer 6

1. Lateral circumflex femoral a. (transverse br.)
2. Inferior gluteal a.
3. Medial circumflex femoral a.
4. First Perforating a. (ascending br.)

• It is located in the upper posterior thigh near the lesser trochanter.*
• Trick: If you don’t have your cruciate, you’re going to LIMP*

Question 7

what is the major blood supply to the hip joint?

Answer 7

The most significant contribution to the hip joint is from the

medial circumflex femoral a.

Additional contributors include the lateral circumflex femoral a., the superior and inferior a., and the artery of the ligament to the head of the femur.

Question 8

the artery of the ligament to the head of the femur arises from which artery?

Answer 8

acetabular branch of the obturator a.

The artery of the ligament to the head of the femur is also called the “foveolar artery” and the “artery to ligamentum capitis femoris”.

Question 9

the femoral artery divides into which two branches?

Answer 9

1. Superficial Femoral (aka “femoral”) a.
2. Deep Femoral (aka “profunda femoris”) a.

Question 10

how does the superficial femoral artery terminate?

Answer 10

it terminates at the adductor hiatus where its name changes to the popliteal artery

Question 11

how does the deep femoral artery terminate?

Answer 11

it gives rise to four perforating arteries that will supply blood to the hamstring muscles

Question 12

name the components of the genicular anastomosis

Answer 12

trick: 2 above, 3 below, 4 center

Above:

• descending branch of the lateral circumflex femoral a.,
• descending genicular a. (incl. the saphenous branch + articular branch)

Below:

• circumflex fibular a.,
• anterior tibial recurrent a.,
• posterior tibial recurrent a.

Center:

• superior lateral genicular a.,
• superior medial genicular a.,
• inferior lateral genicular a.,
• inferior medial genicular a.

Question 13

the popliteal artery terminates as which two major arteries?

Answer 13

1. Anterior tibial a.
2. Posterior tibial a.

The popliteal artery terminates at the soleal line on the posterior aspect of the tibia just distal to the knee joint

Question 14

the anterior tibial artery gives rise to which two arteries of the genicular anastomosis?

Answer 14

1. Anterior tibial recurrent a.
2. Posterior tibial recurrent a.

Question 15

the peroneal artery is a branch of which artery?

Answer 15

posterior tibial a.

• The posterior tibial a. has many branches, but the peroneal a. is considered the largest branch.*
• Another branch of significance is the nutrient a. to the tibia, which is the largest nutrient artery in the body*

Question 16

what are the branches of the peroneal artery?

Answer 16

1. Nutrient branch to the fibula
2. Perforating branch
3. Communicating branch (with posterior tibial a.)
4. Posterior lateral malleolar branches

Question 17

describe the blood supply to the talus

Answer 17

Head & Neck: supplied primarily by the anterior tibial a. (but also from the branches of the posterior tibial a. and peroneal a.)

Body: supplied by the branches of the posterior tibial a. (i.e. artery of the tarsal canal and the deltoid a.)

Posterior tubercles: posterior tibial a. & peroneal a.

Question 18

you palpate the area posterior to the medial malleolus and feel a pulse.

what artery are you palpating?

Answer 18

posterior tibial a.

• The area you are palpating is known as the tarsal tunnel.*
• This artery, along with the accompanying nerve and venae comitantes, make up the third compartment of the tarsal tunnel*

Question 19

the medial and lateral tarsal arteries are branches of which artery?

Answer 19

dorsalis pedis a.

• The dorsalis pedis is a continuation of the anterior tibial artery.*
• It begins at the level of the ankle joint, and can be palpated on the dorsum of the foot lateral to the EHL tendon over the cuneiforms*

Question 20

name the arteries that contribute to the lateral malleolar anastomosis

Answer 20

1. Anterior lateral malleolar a. (anterior tibial a.)
2. Posterior lateral malleolar a. (peroneal a.)
3. Lateral tarsal a. (dorsalis pedis)
4. Lateral plantar a. (posterior tibial a.)
5. Perforating peroneal a.* (peroneal a.)

Question 21

name the arteries that contribute to the medial malleolar anastomosis

Answer 21

1. Anterior medial malleolar a. (anterior tibial a.)
2. Posterior medial malleolar a. (posterior tibial a.)
3. Medial tarsal a. (dorsalis pedis)
4. Medial plantar a. (posterior tibial a.)

Question 22

the dorsalis pedis artery terminates as which two named arteries?

Answer 22

1. First proximal perforating a. (aka deep plantar perforating)
2. First dorsal metatarsal a.

Question 23

from which artery do the dorsal metatarsal arteries arise?

Answer 23

The first dorsal metatarsal artery arises directly from the dorsalis pedis,

while the second, third, and fourth dorsal metatarsal arteries are branches of the arcuate a.

Question 24

the posterior perforating arteries arise from what structure(s) on the dorsum of the foot?

Answer 24

second, third, and fourth dorsal metatarsal arteries

Question 25

the posterior tibial artery divides into which two arteries that supply the plantar aspect of the foot?

Answer 25

1. medial plantar a.
2. lateral plantar a.

Question 26

the main branches of the posterior tibial artery course between which muscle layers upon entering the plantar foot?

Answer 26

Medial plantar artery:

• First (aBductor hallucis) &
• Second (tendon of FDL) muscle layers

Lateral plantar artery:

• First (aBductor hallucis) &
• Second (Quadratus plantae) muscle layers

Question 27

from which artery do the plantar metatarsal arteries arise?

Answer 27

deep plantar arch

(which is a continuation of the lateral plantar a.)

Question 28

what are the major anastomoses between the dorsal and plantar foot?

Answer 28

1. Deep plantar perforating a. + deep plantar arch
2. Posterior perforating arteries + deep plantar arch
3. Anterior perforating arteries (dorsal) + anterior perforating arteries (plantar)

The posterior perforating arteries are also known as the “proximal perforating arteries”, while the anterior perforating arteries are also known as the “distal perforating arteries”.

Question 29

what are the branches of the medial plantar artery?

Answer 29

1. superficial branch
2. deep branch

Question 30

what arteries in the lower extremity do not have accompanying vena comitantes?

Answer 30

1. superficial femoral a.
2. deep femoral a.
3. popliteal a.
4. dorsal digital arteries

When present, venae comitantes are contained w/in the vascular sheath and are part of the arteriovenous pump

Question 31

what anatomic structure demarcates the superficial vs. deep venous system?

Answer 31

deep fascia (crural fascia in leg, fascia lata in the thigh)

The large, named arteries that run with the deep venous system in the lower extremity are also deep to the deep fascia, with one exception (the arteries present in the digits are NOT deep to the deep fascia)

Question 32

which arteries of the foot are superficial to the deep fascia?

Answer 32

proper plantar & proper dorsal digital arteries

All other named arteries in the lower extremity, with the exception of those present in the digits, are deep to the deep fascia

Question 33

the dorsal venous arch of the foot drains into which superficial veins?

Answer 33

Great saphenous vein (medially) &

Lesser saphenous vein (laterally) via the marginal veins

Question 34

which superficial vein drains the foot, and ascends the leg and thigh?

Answer 34

great saphenous vein

Question 35

what veins in the lower extremity have valves?

Answer 35

superficial and deep veins

• the great saphenous vein generally contains 6-25 valves,*
• and the small saphenous vein contains 7-11*

Question 36

what is the direction of flow in the venous system in the lower extremity?

Answer 36

from superficial to deep

• the valves of the communicating or perforating veins are arranged to direct flow from the superficial to the deep system (e.g. lesser saphenous drains into the popliteal vein)*
• however, the dorsum of the foot is different, since blood is directed from the deep to superficial system*

Question 37

an infection travels through the lateral marginal vein.

which set of lymph nodes is most likely to be affected?

Answer 37

popliteal lymph nodes

Trick: remember that lymphatics follow veins. If you know the venous system, you can predict the origin of an infection that leads to lymphadenopathy of the popliteal vs. the inguinal lymph nodes